BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP a...BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.展开更多
Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine...Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed;grade II, thin without visible content;grade III, translucent with visible content;and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.展开更多
Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these pa...Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.展开更多
Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
Background Cesarean scar pregnancy （CSP） is a very rare but life-threatening entity and there is no optimal management strategy.Here we report a successfully conservative treatment of CSP.Methods We retrospectively ...Background Cesarean scar pregnancy （CSP） is a very rare but life-threatening entity and there is no optimal management strategy.Here we report a successfully conservative treatment of CSP.Methods We retrospectively analyzed the clinical data of 54 women with CSP,who underwent uterine artery embolization between January 2007 and September 2012 at the Peking University People＇s Hospital.We evaluated the clinical outcomes,the technique and the complications of uterine artery embolization.Results Of the 54 patients,2 patients with hemorrhage after induced abortion received bilateral uterine artery embolization treatment alone,and 52 patients underwent suction curettage after bilateral uterine artery embolization.All 54 women were successfully cured,without any severe complications,and uterine function was restored.During the follow-up,one patient had accidental normal interuterine pregnancy and received induced abortion during the first trimester.Conclution Uterine artery embolization combined with suction curettage is an effective and safe conservative treatment for cesarean scar pregnancy.展开更多
Despite the optimal therapeutic protocols of cesarean scar pregnancy （CSP） has not been established, and in the majority of cases, most of women＇s uterus and fertility can be preserved through prompt and active tre...Despite the optimal therapeutic protocols of cesarean scar pregnancy （CSP） has not been established, and in the majority of cases, most of women＇s uterus and fertility can be preserved through prompt and active treatment. But due to the rarity of CSP, little is known about the outcome of subsequent pregnancies, especially in an even rarer situation, a recurrent CSP. We report 2 cases of recurrent CSP women who want to preserve their fertility treated by repeated uterine artery embolization and provide a review of the literatures.展开更多
Cesarean scar pregnancy （CSP） occurs when a gestation sac is implanted in the previous lower segment cesarean scar. The incidence of CSP is increasing worldwide. Uterine ateriovenous malformation （UA VM） is a rare...Cesarean scar pregnancy （CSP） occurs when a gestation sac is implanted in the previous lower segment cesarean scar. The incidence of CSP is increasing worldwide. Uterine ateriovenous malformation （UA VM） is a rare gynecologic disease. Both of these diseases can cause severe vaginal bleeding and produce high morbidity rate. We describe a ease of UA VM induced by a CSP. The patient suffered intermittent vaginal bleeding after two dilatation and curettage （D＆C） one month before admission. The suspected diagnosis of CSP and UA VM were made after using transvaginal ultra- sound with color Doppler and human chorionic gonadotropin （hCG） examination. Resection of the involved area including the cesarean scar and UA VM by laparotomy was performed successfully and the diagnosis was confirmed by the last pathologic result.展开更多
Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （...Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as blood loss volume, operation-associated complications, serum hCG level ultrasound imaging and hospitalization cost were analyzed.Results Thirty-eight women accepted D＆C following UAE （group A）, 10 patients had medicine （3 took trichosanthin injection, 7 took MTX injection） before UAE and D＆C （group B）. Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment （group C）. There were no statistically significant differences between group A and group B about the serum fl-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay （P〈0.01） and cheaper cost of hospitalization （P〈0.05） of group A than group B.Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.展开更多
基金Supported by Medical Health Science and Technology Project of Zhejiang Province,China,No.2020ZH003。
文摘BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.
文摘Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed;grade II, thin without visible content;grade III, translucent with visible content;and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.
文摘Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘Background Cesarean scar pregnancy （CSP） is a very rare but life-threatening entity and there is no optimal management strategy.Here we report a successfully conservative treatment of CSP.Methods We retrospectively analyzed the clinical data of 54 women with CSP,who underwent uterine artery embolization between January 2007 and September 2012 at the Peking University People＇s Hospital.We evaluated the clinical outcomes,the technique and the complications of uterine artery embolization.Results Of the 54 patients,2 patients with hemorrhage after induced abortion received bilateral uterine artery embolization treatment alone,and 52 patients underwent suction curettage after bilateral uterine artery embolization.All 54 women were successfully cured,without any severe complications,and uterine function was restored.During the follow-up,one patient had accidental normal interuterine pregnancy and received induced abortion during the first trimester.Conclution Uterine artery embolization combined with suction curettage is an effective and safe conservative treatment for cesarean scar pregnancy.
基金supported by Medical Science and Technology Research Fund of Guangdong(No.B2013063)
文摘Despite the optimal therapeutic protocols of cesarean scar pregnancy （CSP） has not been established, and in the majority of cases, most of women＇s uterus and fertility can be preserved through prompt and active treatment. But due to the rarity of CSP, little is known about the outcome of subsequent pregnancies, especially in an even rarer situation, a recurrent CSP. We report 2 cases of recurrent CSP women who want to preserve their fertility treated by repeated uterine artery embolization and provide a review of the literatures.
文摘Cesarean scar pregnancy （CSP） occurs when a gestation sac is implanted in the previous lower segment cesarean scar. The incidence of CSP is increasing worldwide. Uterine ateriovenous malformation （UA VM） is a rare gynecologic disease. Both of these diseases can cause severe vaginal bleeding and produce high morbidity rate. We describe a ease of UA VM induced by a CSP. The patient suffered intermittent vaginal bleeding after two dilatation and curettage （D＆C） one month before admission. The suspected diagnosis of CSP and UA VM were made after using transvaginal ultra- sound with color Doppler and human chorionic gonadotropin （hCG） examination. Resection of the involved area including the cesarean scar and UA VM by laparotomy was performed successfully and the diagnosis was confirmed by the last pathologic result.
文摘Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as blood loss volume, operation-associated complications, serum hCG level ultrasound imaging and hospitalization cost were analyzed.Results Thirty-eight women accepted D＆C following UAE （group A）, 10 patients had medicine （3 took trichosanthin injection, 7 took MTX injection） before UAE and D＆C （group B）. Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment （group C）. There were no statistically significant differences between group A and group B about the serum fl-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay （P〈0.01） and cheaper cost of hospitalization （P〈0.05） of group A than group B.Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.
